Objective: To analyze the institutional and regional differences in influenza vaccination for teachers and students, so as to provide a basis for influenza prevention and control in campus. Methods: Influenza vaccination data for teachers and students in Shandong Province from 2015 to 2024 were collected from Immunization Information Systems. Joinpoint regression models were used to calculate the annual percent change (APC) and average annual percent change (AAPC) in first-dose vaccination rates. Results: The vaccination coverages for the first dose of influenza vaccine among teachers in Shandong Province from 2015 to 2024 were 0.01%, 0.02%, 0.15%, 0.29%, 0.60%, 2.06%, 1.64%, 2.27%, 3.00%, and 2.43%, with a turning point in 2020. For preschools, primary/secondary schools, and higher education institutions, APCs during 2015-2020 were 163.36%, 162.09%, and 174.94%, respectively( P <0.01), declining to 9.53%, 9.92%, and 8.14% during 2020-2024( P >0.05). Corresponding AAPCs were 78.32%, 78.13%, and 81.61%( P <0.01). High, middle, and low GDP regions exhibited APCs of 173.84%, 162.75%, and 136.67% during 2015-2020( P <0.01) and 5.77%, 13.92%, and 11.86% during 2020-2024( P >0.05), with AAPCs of 79.42%, 81.23% , and 69.63%( P <0.01), respectively. Among students, vaccination coverage ranged from 1.59% to 7.20%. Preschool students showed no turning points, with an AAPC of 18.73%( P <0.01). Primary/secondary students had turning points in 2018 and 2022, APCs were -32.59% during 2015-2018( P <0.01), 48.45% during 2018-2022( P <0.01), and -26.25% during 2022-2024( P =0.04), yielding an AAPC of -2.32%( P =0.45). Higher education students had a turning point in 2020, with APCs of 63.27% during 2015-2020( P <0.01) and 4.31% during 2020-2024 ( P =0.77), and the AAPC was 33.79% during 2015-2024 ( P <0.01). High, middle, and low GDP regions for students showed no turning points, with AAPCs of 10.46%( P =0.18), 13.67%( P =0.01), and 10.42%( P = 0.05 ), respectively. Conclusions The influenza vaccination rate among teachers and students in Shandong Province has shown an upward trend from 2015 to 2024, but the overall level is still relatively low. However, continued efforts are needed to enhance health education on influenza and vaccination, to further improve the vaccination rate of teachers and students.

Traditional Chinese medicine （TCM） has a long history of application in China and has consistently played a vital role in treating diseases and saving lives. TCM prescriptions （compounds） constitute the primary form of clinical TCM treatment and significantly differ from western medicine （chemicals） due to the diverse composition and chemical constituents of TCM （compounds）. Nevertheless， the potential multi-component， multi-target， and multi-pathway action characteristics of TCM prescriptions also demonstrate their possible （complementary） therapeutic advantages when compared with single-component chemical drugs. Therefore， driven by the development of modern science and technology and the demands of the modernization and internationalization of TCM， modern theories regarding the complexity of TCM prescription effects have been continuously proposed： Different from the abstract language of traditional prescription theory， the modern TCM prescription theory is more inclined to illustrate the connotation of prescription compatibility concretely and vividly from an experimental and scientific perspective. In this paper， new theories on the complexity of TCM prescriptions proposed in recent years are summarized to provide research references and ideas for the greater role of TCM prescriptions and a better scientific understanding.

Objective:To investigate the application effect of research-assisted teaching mode in histology teaching by taking the construction of rat spinal cord injury model as an example.Methods:A convenient sampling method was used to select 52 freshmen majoring in clinical medicine of grade 2020 in our school as the research subjects.They were randomly divided into the conventional teaching group and the research-assisted teaching group,with 26 students in each group.The conventional teaching group received traditional classroom teaching combined with experimental teaching.On this basis,research elements were added to the experimental teaching in the research-assisted teaching group to provide more in-depth research methods and experimental design,so as to cultivate students'research abilities.The theoretical assessment and practical skills assessment of histology course were compared between the two groups.A subjective evaluation questionnaire on experimental animal models teaching was used to evaluate the advantages of teaching programs in three dimensions:psychological quality training,technical skill enhancement,and theoretical knowledge expansion.The research abilities of the two groups were compared.Pearson correlation analysis was used to analyze the correlation between research ability scores and comprehensive scores.Results:The usual score and comprehensive score in the research-assisted teaching group were significantly higher than those in the conventional teaching group(P＜0.05).The scores of adaptability to challenging tasks,determination and perseverance in problem-solving,communication skills in teamwork,literature reading,integration of practical experience with theoretical knowledge,practical application value of the course,and innovation of teaching resources in the research-assisted teaching group were higher than those in the conventional teaching group(P＜0.05).The scores in experimental design ability,background knowledge in literature review,communication and reporting skills,awareness of evidence-based medicine,and overall research ability in the research-assisted teaching group were higher than those in the conventional teaching group(P＜0.05).The total score of students'research abilities was positively correlated with comprehensive scores(r=0.716,P＜0.01).Conclusions:The application of research-assisted teaching significantly improved students'research abilities in histology teaching.The enhancement of research abilities can promote the mastery of theoretical knowledge and the improvement of experimental skills.

Objective:To verify the accuracy and feasibility of radioactive 125I seed implantation assisted by an optical navigation system and a 3D-printing non-coplanar template in the treatment of recurrent head and neck cancers. Methods:A total of 12 patients with recurrent head and neck cancer treated with radioactive 125I seed implantation assisted by an optical navigation system and 3D-printing non-coplanar template were enrolled from Dec 2018 to Dec 2019.The pre-plan and post-implant implantation needle number and implanted seed number were recorded.Meanwhile, their dosimetric parameters were compared, including D90, minimum peripheral dose (MPD), V100, V150, V200, conformity index (CI), external index (EI), and the homogeneity index (HI) of the target volume. Results:The median lesion volume was 31.5 cm 3, the median number of seeds was 61.5, and the median prescription dose was 130 Gy.The means of the pre-plan D90, MPD, V100, V150 and V200 were 134.2, 64.6, 93.3, 75.3 and 39.3 Gy, respectively, while those of post-implant D90, MPD, V100, V150, and V200 were 146.7, 68.94, 97.47, 80.40 and 48.30 Gy, respectively, with no statistically significant difference ( P>0.05). Meanwhile, there was no statistically significant difference between the pre-plan and post-implantation needle number, implanted seed number, CI, HI, and EI ( P>0.05). In terms of postoperative dose quality assessment, eight cases were rated excellent (66.6%) and four cases were rated good (33.3%). Conclusions:Radioactive 125I seed implantation assisted by an optical navigation system and 3D-printing non-coplanar template can be accurately performed in the treatment of recurrent head and neck cancer, with good consistency between pre-plan and post-implant dosimetric parameters and thus of prospective potential in clinical application.

Objective: To compare the preoperative and postoperative dosimetric parameters in the treatment of spinal metastasis, and to verify the accuracy of 3D-printing non-coplanar template (3D-PNCT) combined with CT-guided ¹²⁵I seed implantation for the treatment of spinal metastasis. Methods: The treatment plans of 7 patients with spinal metastasis (9 lesions) from 2016 to 2018 receiving 3D-PNCT in combination with CT-guided ¹²⁵I seed implantation were retrospectively analyzed. The dosimetric parameters including homogeneity index (HI), conformal index (CI), external index (EI), dose of 90% target volume(D₉₀), mPD, volume percent of 100%, 150%, and 200% prescribed dose V₁₀₀、V₁₅₀、V₂₀₀ and D_2cm³ of spinal cord were compared before and after operation. The british columbia cancer ageny particle implantation quality evaluation standard was applied to evaluate the quality of implantation. Results: The HI, EI and CI, D₉₀, mPD, V₁₀₀, V₁₅₀, V₂₀₀ and D_2cm³ of spinal cord did not significantly differ before and after the plan (all P>0.05). Five were evaluated as excellent and 4 were assessed as good. Conclusion The postoperative dosimetric parameters of 3D-PNCT combined with CT guided ¹²⁵I seed implantation of spinal metastasis are basically consistent with preoperative dosimetric parameters. The postoperative plans are evaluated as excellent or good, suggesting that the technology has a good therapeutic accuracy in the treatment of spinal metastasis.

Objective To compare the dose distribution of postoperative plans with preoperative plans of 3D-printing template (coplanar and non-coplanar) assisted and CT-guided 125I seed implantation for the treatment of soft tissue sarcoma,and to explore the accuracy of treatment at dosimetry level.Methods From December 2015 to July 2017,19 patients with soft tissue sarcoma (a total of 25 lesions)were treated with 3D printing template assisted and CT-guided 125I seed implantation in Peking University Third Hospital.All patients underwent preoperative assessment,CT simulation orientation,preoperative planning,3D-template printing,3D-template reduction,needle and seed implantation,postoperative dosimetry assessment,postoperative care and follow-up.The preoperative and postoperative dosimetric parameters were conpared.Ten cases of soft tissue sarcoma in superficial trunk or limbs were screened.Preoperative planning of coplanar template and non-coplanar template were designed respectively.The dosimetric parameters of preoperative planning guided of two templates were compared.Results Twentyfive 3D-printing templates were designed and constructed,and 25 lesions were totalled.There was no statistical difference between preoperative and postoperative dosimetric parameters.There was no statistical difference of the preoperative plan's dosimetric parameters between coplanar and non-coplanar in soft tissue sarcoma of superficial trunk/limbs.Conclusions The validation of actual dose distribution in postoperative plans assisted by 3D-printing template in 125I seed implantation showed that most of parameters could meet the expectation of preoperative plans,which indicated the improvement in accuracy for this new modality.For soft tissue sarcoma located in the superficial trunk/limbs,it was recommended to select the 3D-printing coplanar template firstly.

Objective To investigate the feasibility of 3D-printing coplanar coordinate template (3D-PCT) for guiding 125I radioactive seed implantation in the treatment of pelvic wall recurrence of cervical cancer on ensuring the accuracy of dose.Methods From Oct 2016 to Dec 2017 in Peking University Third Hospital,totally 10 patients with pelvic wall recurrent cervical cancer after radiotherapy were treated with 125I radioactive seed implantation assisted by 3D-PCT.The median age was 53.5 years old (37-71 years old).KPS score of the cohort were more than 70.All patients had received pelvic radiation therapy previously.The median volume of the lesion was 31.9 cm3 (3.5-58.0 cm3).The prescription dose was 120-180 Gy.The activity of seeds was 0.55-0.67 mCi(1 Ci =3.7 × 1010Bq),while the number of seeds was 12-81 (median 50) on preoperative plan.Radioactive seeds implantation was performed under 3D-PCT guidance according to the preoperative plan.The actual number of implanted seeds was 53 (10-82).Dosimetry parameters of preoperative plan and postoperative plan including D90,D100,V100,V150,V200,external index (EI),conformal index (CI),heterogeneity index (HI),and organat-risk doses of D2 cm3,D1 cm3 and D0.1 cm3 were compared using the nonparametric test.Results The seed number of postoperative plan was more than that of preoperative plan (Z =-2.255,P ＜ 0.05),but all of the dosimetric parameters showed no significant difference (P ＞ 0.05).D2 cm3 and D1 cm3 of rectum for postoperative plan were lower than that of preoperative plan (Z =-2.100,-2.240,P ＜ 0.05),while other dose parameters of normal tisssues showed no statistically significant difference (P ＞ 0.05).Conclusions Assisted by 3D-PCT for 125I radioactive seed implantation in pelvic wall recurrence of cervical cancer,the actual postoperative dose could meet the requirement of the preoperatie plan through the intraoperative optimization of dose.3D-PCT could ensure the precise of delivered dose of 125I radioactive seed implantation.

Objective To compare the dose distributions of postoperative plans with preoperative plans for 3D printing guide plate assist radioactive seeds implantations, explore the effects of the technology for seeds implantations in dosimetry level. Methods From January 2016 to December 2016, a total of 42 patients of local recurrent malignant tumor of head and neck received 3D printing guide plate assist radioactive seeds implantations in in Peking University Third Hospital, and included in the retrospective study. The prescribed dose was 110 -160 Gy. All patients carried out preoperative planning design, individual guide plate production, and compared the dose distribution of postoperative plan with preoperative plan. Dose parameters include D90 , mPD, V100 , V150 , V200 , CI, EI and HI. Statistical method was paired t-test. Results A total of 423D printing individual templates were produced. The mean GTV volume of all patients was 28. 6 cm3 , and mean D90 of postoperative target area ( GTV) was 142. 6 Gy. For postoperative plans, the mean D90 , mPD, V100 , V150, V200 was 142. 6 Gy, 77. 3 Gy, 92. 48％, 68. 40％and 42. 98％, respectively, and 144. 5 Gy, 70. 2 Gy, 91. 45％, 63. 12％ and 34. 74％, respectively, in preoperative plans. Except mPD, V150, V200(t= -2. 166, -2. 863, -4. 778, P<0. 05), there was no significant difference between the two groups. Conclusions 3D printing guide plate could provide good accuracy for positioning and direction. For local recurrent malignant tumor of head and neck, the actual dose distributions in postoperative validations were close to the expectations of preoperative plans which mean the improvement of accuracy in treatment.

Objective To investigate the utilization rate of gold fiducial markers and reasons for abandonment of gold fiducial markers in the CyberKnife VSI System, and to provide reference data for implantation of gold fiducial markers and radiotherapy planning. Methods From March to August,2017,a total of 47 patients had gold fiducial markers implanted or pasted. In those patients, 42 patients had gold fiducial markers implanted,including 32 receiving computed tomography(CT)-guided 3D-printing coplanar template assisted implantation, 1 receiving CT-guided 3D-printing non-coplanar template assisted implantation,1 receiving CT-guided implantation,and 8 receiving ultrasound-guided implantation. A total of 44 patients received the CyberKnife treatment, including 2 patients who failed to use gold fiducial markers and were treated with spine tracking instead and 3 patients missing the treatment for other reasons. The numbers of utilized and abandoned gold fiducial markers were recorded for calculation of the utilization and abandonment rates. The reasons for abandonment of gold fiducial markers were analyzed and classified. Results A total of 134 gold fiducial markers were implanted into or pasted to the 44 patients.In all the gold fiducial markers, 111 were utilized and 23 abandoned, yielding a utilization rate of 82.8% and an abandonment rate of 17.2%.The reasons for abandonment of gold fiducial markers included large rigidity error(26.1%), unqualified implanted fold fiducial markers(17.4%), displacement of gold fiducial markers(26.1%), and others(30.4%). Conclusions Compared with the CT-guided or ultrasound-guided implantation of gold fiducial markers, the CT-guided 3D-printing coplanar or non-coplanar template assisted implantation of gold fiducial markers requires only two puncture needles for each implantation and implants two gold fiducial markers by a single needle,which reduces the number of puncture needles,risk of puncture-induced injury,and incidence of complications after implantation. Not all the gold fiducial markers implanted by a variety of ways will be utilized. Some gold fiducial markers will be abandoned for different reasons,which should be taken into account during implantation of gold fiducial markers.

Objective To evaluate the clinical efficacy and safety of CT-guided 125 I seed implantation in the treatment of recurrent head and neck tumors after radiotherapy. Methods Clinical data of 101 patients who received CT-guided radioactive 125 I seed implantation for recurrent head and neck cancer after radiotherapy from 2007 to 2015 were retrospectively analyzed. The median accumulated dose of external radiotherapy was 66 Gy and the median dose after seed implantation (D90) was 117 Gy. The local progression-free survival and overall survival were analyzed by Kaplan-Meier method. Univariate analysis was performed by log-rank test and multivariate analysis was conducted by using Cox regression model. Results The median follow-up time was 12. 2 months. The 5-year local progression-free survival rate was 26. 6％.The 5-year overall survival rate was 15. 5％. Univariate analysis demonstrated that age,pathological type,implantation site,lesion volume,D90 and short-term efficacy were correlated with local control,and KPS score,lesion volume ,D90,and short-term efficacy were associated with survival (all P<0. 05). Multivariate analysis revealed that pathological type,lesion volume ,D90 and short-term efficacy were independent factors related to local control (P= 0. 000, 0. 002,0. 003 and 0. 014).In terms of the adverse events,skin/ mucosal ulceration was observed in 25. 7％ and pain occurred in 13. 9％ of all patients. No correlation was noted between the adverse events and dose.Conclusions CT-guided radioactive 125 I seed implantation is an efficacious and safe treatment of recurrent head and neck tumors after radiotherapy. Non-squamous carcinoma,small lesion volume and high dose (D90) indicate excellent local control.